


Ba, Ka, Ankh

by shellcollector



Category: Les Misérables - All Media Types
Genre: Detailed description of a tracheotomy, Egyptology, Graphic Depictions of Illness, Hieroglyphics, M/M, Nineteenth century medicine, Surgery
Language: English
Status: Completed
Published: 2019-08-29
Updated: 2019-08-29
Packaged: 2020-09-29 12:56:49
Rating: Teen And Up Audiences
Warnings: Creator Chose Not To Use Archive Warnings
Chapters: 1
Words: 2,207
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/20436404
Author URL: https://archiveofourown.org/users/shellcollector/pseuds/shellcollector
Summary: Ba: the physical part of the soul. Often depicted as a bird, flying between the worlds of the living and of the dead.Ka: the breath of life.Ankh: the union of the two created in the afterlife; the enlightened soul.





	Ba, Ka, Ankh

**Author's Note:**

  * For [pelides](https://archiveofourown.org/users/pelides/gifts).

_ **Ba** _

  
“And this one?”

Enjolras pointed to where Combeferre had only recently traced, with a scratchy pen prone to blotting, a whole row of copies of the same symbol.

“This one can be an ideogram or an alphabetical - that is, it makes the sound ‘nefer’, but it also means beautiful, or simply good. Horapollo says it shows a heart suspended from a windpipe, but that may be fanciful; most of today’s scholars would call it a lyre.”

Enjolras sat himself up in the bed and touched one of the copies with his finger, a heart shape below two parallel horizontal lines, with a ribbed funnel running between them. He lifted his hand; the ink, still wet, had printed two of the funnel’s ridges onto his fingertip.

“And you?” he asked. His voice was starting to sound a little hoarse; the cold which was the occasion for his being ordered to bed rest had clearly begun to settle upon the larynx.

Combeferre sighed.

“I’m not sure. I’m sure many would say that a lyre was more likely, as a symbol of beauty, than something out of a butcher’s shop.”

Enjolras gave him a look, one which said, very clearly, _not you, though._ Combeferre found it startling sometimes, how Enjolras, so often opaque, could suddenly become transparent; it presented a mirror image of the way that he could pass, almost mid-sentence, from eloquence to wordlessness.

An image, of a white-ribbed trachea, mid-dissection, his pencil copying the arc of muscle between each ridge. Was that beautiful?

He rubbed at the bridge of his nose.

“Perhaps I’m a little fanciful myself. I’m sure I bring my own associations; but surely we should remember the importance of the heart, to the Egyptians. It was the soul’s casing, its envelope. And then there’s the windpipe; Horapollo glosses it as _voice_, the voice of a good man; but if we thought of it instead as the conduit of breath - that is to say, of the mind - it’s a possibility that shouldn’t be ruled out. I’ve thought of writing to Champollion.”

Enjolras nodded, was silent for a minute, staring at the page, then pointed at another of the symbols.

“And this?”

“This is a composite; two reeds beneath a hoe, or plough; it’s found in proper names, beside the name of a god; it means beloved.”

So this was what they were doing, it seemed. Combeferre had heard that the blind liked to run their fingers over the faces of those they spoke to, in order to determine expression and contour. This felt similar; the gentle probing of Enjolras’ questions was like the cool touch of fingertips on his skin. He took Enjolras’ hand in his, turned it upwards to show the palm, the pad of the index finger still marked with the tracheal ridges.

“A hand, drawn sideways, thumb upward,” he said, “is called _tot_; it is the equivalent of tau, the letter T.”

The slender, long fingers curled inwards, the hand cradled in his own.

  
_ **Ka** _

  
The mother was terrified. The blue-lipped child in her arms was arching his neck backwards and splaying his hands, as if stretching far enough would allow him to reach some undiscovered seam of rich air.

“He's been ill for a few days,” she said. “But it was just a sore throat, a little horseness, and then this morning - oh god, oh god. I don’t think he can breathe. Please, please, oh god.”

“What’s his name?”

“Jacques.”

“Come, Jacques.” said Combeferre, as gently as he could. “I’ll have to look at your throat. Do you think you could open your mouth for me?”

The child’s wide eyes met his; it was clear that understanding remained, despite the impossibility of speech. The neck straightened, although his face continued to convulse with the effort of each thin, whining hiss of a breath.

“Good boy,” murmured Combeferre, trying to make the smile he shot the child’s mother as reassuring as possible. He depressed the child’s tongue and peered into his mouth. Covering all of the inner surfaces, but particularly thickly towards the back, was, as he’d expected, a thick, silver-grey false membrane, bilateral, almost entirely blocking the small throat. He reached inside with a probe, trying to ascertain whether it could be loosened from the surface of the mucosa, but the child only coughed and stiffened.

“I’m going to listen to your chest,” he said, although he knew everything he needed to; but he needed the ritual, if only to give himself space to think. This child will die, he thought to himself as he listened to the rapid heartbeat, the stridorous, shallow breath. The pellicles have reached the larynx; the trachea is closing rapidly. The mother will have to be told.

His mind conjured again the picture of the tracheal rings printed on Enjolras’ finger; and of his dissecting table, the knife easing itself through the fibrous tube.

He’d read Bretonneau’s reports, of course, and heard Trousseau speak of the technique of tracheostomy. He had himself prepared a curved steel cannula, of suitable width, and kept it among his instruments for this purpose. And he knew that he had no second option, no gentle course; he could allow this child to die, or he could try an operation he knew only from its description and a couple of illustrated plates.

“Have you assisted with a surgery before?” he said, quietly and quickly, to one of the externs. 

“Surgery?”

The extern, a stocky, nervy young man named Fontaine, looked more frightened than ever.

“Yes. We're going to open the trachea, and I'll need you to hold the muscles of the neck and the base of the thyroid gland away from where I'm making the incision. Do you think you could do that?”

Fontaine nodded. The mother was crying.

“What’s happening, what’s going on? Oh, my god. Mother Mary, please in your mercy —”

“Listen to me,” said Combeferre, making an effort to slow down his voice and lower its pitch to give it a gentler tone. “Your child is very ill. He has something we call diphtheria. His throat is closing up, and soon he won’t be able to breathe at all.”

She began to sob.

“We’re going to try to save him. He needs an operation, just here —” he indicated a spot on his throat “— to allow the air to get into his lungs. It’s just a small cut, and when he’s better we’ll sew it up again. This is the best thing we can do. It’s new thing, this operation. He’s very, very ill, and it might not work. But it’s the best thing, the most scientific thing, and I think we should give him a chance.”

She nodded.

“Can you hold him while I make the cut? Or would you rather have someone else do that?”

“No, Monsieur.” she shook her head. “He needs his mother, I think.”

“Good.”

He directed the extern to stand behind the child's head. The boy’s breathing had become a strangled wail, his eyes watering with the effort of it. Combeferre took a couple of deep breaths of his own. He tried to remember his own drawings of the trachea.

“Hold him as still as you can, with his head tilted back, like this,” he told the mother, as he took out his scalpel. 

He felt around on the child’s neck, trying to note the placement of the thyroid and cricoid. Everything was so much smaller than it had been on the adult corpses he’d dissected; for a moment he worried that the cannula would be too large after all; should he have asked for a gum-elastic catheter, as a backup? But there was no time to delay further; the boy’s face was turning a blotchy purple.

He pressed the scalpel delicately into the child’s throat, praying he wouldn’t hit some unforeseen artery. He made a short, shallow vertical cut, and then separated the skin with two hooked probes pulled to each side.

“Take these,” he said, handing the probes to Fontaine and then, reminding himself of the need to be reassuring, “That's it. You're doing really well. Keep scooping the subcutaneous tissue away from the wound as I continue to cut.”

Combeferre gradually deepened the wound, exposing the trachea. He palpated its whitish rings, planning the cut with some care, and slid in his knife. Even without the cannula he could feel the air being sucked inwards as the child’s chest rose.

Taking a pair of curved forceps, he pulled the tracheal tube open. Air began to flow more easily in and out; he felt the subtle breeze of it on his bloody fingers.

Now all that remained was the placement of the cannula.

He reached for it, slid it into the opening, between the forceps, and the boy coughed a little blood out of the cannula, then inhaled a deep, full breath. It was followed by another, and then another. His lips began to pinken, and the bruisy blotching of his face subsided. He relaxed in his mother’s arms.

Combeferre sighed himself. Fontaine, the extern, looked pale and shaken. Combeferre took the probes from him and gently released them, stabilising the cannula as the muscles of the neck settled around them.

He poured out some water for them to wash the blood from their hands.

“He’s breathing,” he said. “Now we just need to bandage the cannula in place. And I think a few grains of calomel, _per os_, to contain the inflammation.”

Fontaine nodded dumbly, as if he hardly believed it.

  
_ **Akh** _

  
“And you think he’ll live?”

Combeferre shrugged hopelessly.

“I hope he will. Who knows, of course, what will happen. The tube could block, or the membranes could spread further down into the bronchi. The wound may develop an infection. He might simply be too exhausted by the illness to recover.”

“But he may live. And without you he would certainly have died.”

“Well, yes.”

“That is… very beautiful.”

“But I was so frightened, Enjolras.”

“It’s terrifying, sometimes, to stare straight into the future. It’s like looking at the sun.”

They were quiet for a little while, and then Combeferre said,

“Prouvaire will be very satisfied with your case, I think. Two days languishing in bed, and you’ve become quite poetical. I shall have to write it up as a case report.”

Enjolras gave a quiet laugh, which turned into a cough. Combeferre tensed.

“I should take a look at you.”

“If you have to.”

As he was screwing the stethoscope together, he noticed, quite dispassionately, that his hands were shaking.

“You’re frightened now,” said Enjolras, who had evidently noticed it too.

“Yes.”

“Do you have any cause to be?”

He shook his head. “No. I think you’ve a bad cold and a fever, but I doubt it’s anything more than that.”

“But you’re afraid, still.”

“Yes.”

Was he turning into Joly, always seeing some terrible spectre around the corner, an echo of the day’s cases in the evening’s symptoms? His hands wouldn’t stop shaking.

“Tell me how it works.”

“What?”

“The auscultation. Tell me what it is you do.”

Combeferre met Enjolras’ gaze; Enjolras looked into his eyes with that directness that was so peculiarly his own, and that little smile, also.

“Well,” Combeferre said. “the thoracic cavity is really like a kind of drum, or, to think of it another way, it’s like a balloon; on each inbreath it fills with air, the lungs expand and inflate, each pocket opens and swells, the balloon is ready to soar; on each outbreath it sinks back, the fires are extinguished, everything begins to collapse. If you put your ear to the chest, you can hear a little of what is happening inside, the rumble of the drumskin, let’s say, but the tube carries sound so much more clearly. The heartbeat isn’t just a rhythm, it’s all the sounds of the heart itself moving, the muscular contraction and the sound of blood pulling in and out, like a tide. Then, you strike the skin of the drum, and listen for the sounds it makes as it travels through the chest. You hear every part of it, and you learn to know what fluid sounds like and which lobe it is in, what is an obstruction and where it is located, the sound of crackles and rhales and wheezing. In the end you can picture all of them in your mind; it’s as if you yourself travel through the tube, into another kingdom, inside the body, where there is no light and so hearing must take the place of sight. You move around within it - this great mechanism, this palace of flesh and bone. You learn each chamber and corridor, where to find the great halls and where the smallest cells. When something is wrong, you see it in your mind’s eye, almost as clearly as if it were face to face. That’s what auscultation is.”

Enjolras was still looking at him, giving him again that little smile, clouded only by the dreaminess that sometimes came upon him, when they spoke about the world’s possibilities. He took Combeferre’s hand, which had ceased its shaking.

“Do it, then,” he said. “Discover me.”

Combeferre gave his hand a squeeze, and finished assembling the stethoscope.

**Author's Note:**

> Note that the specifics of the Egyptian conception of the soul would not have been known to Combeferre, as the key texts were still a way off from being deciphered; the section names and title represent the author's commentary on the story, not Combeferre's own understanding of it.
> 
> The hieroglyph he and Enjolras discusses was, indeed, not a lyre. It was also not a single symbol; in fact, two separate hieroglyphs had been misidentified as 'lyre' and mistakenly conflated. One, which Combeferre has been copying, really was a 'heart and trachea'. The other was a 'lungs and trachea', which was the symbol for the unity of two halves, possibly because of the way that the trachea branches into two bronchi. 
> 
> The operation that Combeferre performs, tracheostomy for the treatment of diphtheria, had been pioneered by Bretonneau and Trousseau in Tours, although Trousseau later moved to Paris. I have taken most of the details of the operation from Bretonneau's own writeups, which he published throughout the 1820s and then in a collected edition in 1833, as well as from a later description by Eugène Bouchut. You'll just have to take my word for it that I have significantly reduced the amount of a) spewing chunks of psuedomembrane and b) mercury involved, in order to make for a more enjoyable reading experience.


End file.
